OA-154: Information Does Not Support Day's Supply

What Does OA-154 Mean?

When paired with Group Code OA, CARC 154 (Information Does Not Support Day's Supply) is processed as an adjustment outside the standard CO/PR classifications. This typically occurs in secondary payer or coordination of benefits scenarios. Review the remittance details and the COB arrangement to determine financial responsibility and appropriate next steps.

CARC 154 indicates information does not support day's supply. The payer determined that the service or a portion of it does not meet coverage criteria under the patient's current plan benefits or the applicable coverage rules.

Common scenarios that trigger this adjustment include: the quantity dispensed exceeds the payer's maximum day's supply limit for the medication, such as billing a 90-day supply when the plan only covers 30-day supplies; The day's supply listed on the claim does not mathematically match the quantity dispensed and the prescribed dosing frequency; The claim was submitted before the previous day's supply should have been exhausted, suggesting duplicate or premature dispensing. The group code paired with CARC 154 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, OA indicates a coordination of benefits or other payer adjustment, PR shifts it to the patient.

How to Resolve

1. Review the coordination of benefits Examine the OA-154 adjustment to understand how it fits within the primary/secondary payer relationship or other multi-payer context.
2. Verify primary payer adjudication Review the primary payer's EOB to understand the basis for the secondary payer's OA adjustment.
3. Determine the responsible party Based on the COB review, identify whether the adjustment should be absorbed, billed to another payer, or if additional documentation is needed.
4. Appeal or resubmit if needed If the OA adjustment appears incorrect based on the COB arrangement, submit an appeal or corrected claim with the appropriate documentation.
5. Follow up Monitor the claim status and take additional action as needed based on the COB determination.

How to Prevent OA-154

• Maintain accurate coordination of benefits information
• Verify secondary payer requirements before claim submission

Also Filed As

The same CARC 154 may appear with different Group Codes:

Related Denial Codes